Identifying new income streams

Dr Angela Lennox had to find a range of new funding streams to set up a multiagency health centre. Here, she explains what's out there for GPs

NHS chief executive David Nicholson repeatedly warns us the NHS must plan for real-terms cuts, yet the demands on our practices are escalating. So where can GPs turn in looking for additional sources of income to innovate and develop new ways of delivering patient-centred, quality services?

In 1996, I developed Prince Philip House in Leicester city centre – one of the first modern, multiagency health and community centres. In raising money for the centre, I discovered a range of funding opportunities without which the development would never have happened.

The following provides a brief overview of these kinds of funding stream. It is intended to stimulate lateral thinking rather than be an exhaustive list.

NHS Innovation funding

Lord Darzi's NHS Next Stage Review set out a vision for making innovation central to the health service, backed with a £220m fund. Each SHA will receive £2m this year and £5m in each of the following four years to support frontline NHS staff in developing innovative ideas. Funding will be invested directly into a combination of projects on the ground and at regional level – intended to improve healthcare delivery, health improvement or patient engagement.

The current round of proposals has just closed, so this is an ideal time to prepare for the next. Go to www.dh.gov.uk and click on ‘Healthcare', then ‘High quality care for all', then ‘Innovation', or check the website of your local SHA.

Local area agreements

You could piggyback on the broad array of local health-promoting activities, rather than starting from scratch. Local area agreements are developed by councils with their partners to improve the quality of life for local people. Each of the 150 LAAs in England deals with themes across investing in children, reducing our carbon footprint, creating safer and stronger communities, improving health and wellbeing, and addressing worklessness. Identify your local strategic partnerships lead and review LAAs to identify areas of interest. For more details visit www.idea.gov.uk and click on ‘Knowledge' and ‘Local area agreements'.

Personalisation agenda

The ‘personalisation agenda' can open up new opportunities to work as part of an expert partnership with patients and develop new models of care. The Centres for Independent Living can help here. These are not-for-profit organisations run by disabled people, with the aim of promoting independent living, and enabling disabled people to have control and choice over their lives. Their website provides up-to-date contact information on your local centre, the direct payments support scheme and social services operating in your area – see www.ncil.org.uk/directory.asp.

Back-to-work schemes

There is growing evidence that health, work and wellbeing need to be addressed holistically. Dame Carol Black is leading the Working for Health initiative in England, which aims to support people to return to work after an illness. A number of ‘fit-for-work' pilot schemes are under way and although Government funds are only available until March 2011, all the pilots are committed to ensuring their services are sustainable over the long term. See www.workingforhealth.gov.uk for details.

Charities

There are a large number of local and national charities that you may not be aware of, and whose objectives may match your interests and ambitions. Nowadays, it is easier than it used to be to track local charities down, via their websites, or see the Charities Aid Foundation at www.cafonline. org/apps/charities/CharitySearch.aspx.

Grant Finder is a free service that can also help you to identify funding awards that would be appropriate for your project. The information on GrantNet comprises in excess of 5,000 funding schemes available in the UK from European and national sources – see www.grantnet.com.

The Government also provides access to funding organisations through the website www.governmentfunding.org.uk. Although designed for the voluntary and community sector, it provides information on funding across local authorities, regional and central government, independent grant administrators and Europe-wide bodies.

Big Lottery Fund

Every year the Big Lottery Fund's Awards for All programme gives out millions of pounds from the National Lottery to good causes. The money goes to community groups and projects that improve health, education and the environment. Log on to www.awardsforall.org.uk.

Many charitable and Government grants require the funding recipient to be not-for-profit or from the charitable sector. So it is important to consider whether your project qualifies under the conditions and whether your service could be provided as part of a social enterprise, a charity or a partnership with existing community bodies. The Department of Health is encouraging formation of social enterprises as a viable option for those in the healthcare profession looking for a way to tackle unmet needs. Go to www.dh.gov.uk and search for ‘Social enterprise making a difference' for a useful document to download.

Education and training

Undergraduate

Increasing practice involvement in education and training brings benefits to students and the practice alike. It also brings a range of new funding opportunities to the practice. Medical schools generally struggle to shift the balance of undergraduate medical training away from the acute sector into primary care to reflect the changing picture of healthcare delivery.

Medical student training is supported with Special Increment For Teaching (SIFT) funding, and can therefore not only benefit the practice in acquiring educational expertise and profile, but also in attracting funding to support the protected time and facilities required.

Foundation year

The foundation programme has replaced the PRHO year and the first SHO year. The Modernising Medical Careers Strategy describes the programme structure, content and context. It emphasises the diagnosis and management of the acutely ill patient as a key aim, not simply in acute hospitals, but also in mental health and general practice settings.

Contact your local deanery to explore opportunities to support a foundation doctor in your practice. Go to www.mmc.nhs.uk and click on ‘Colleges and deaneries' and then ‘Deaneries'.

GP registrars

Placements are constantly in demand, particularly in practices where health inequalities are greatest. Consider whether your practice could be trained to support a GP registrar or alternatively work with local GPs or through your practice-based commissioning group if you feel unable to undertake the full commitment to training on your own. Again, your local deanery can provide support and guidance on becoming a training practice (see website above).

In addition to funding for delivery of GP registrar training, there may also be funding available to convert or refurbish accommodation and pay equipment costs to increase training capacity. Your deanery can provide further details.

PMETB is the independent regulatory body responsible for postgraduate medical education to ensure that training for doctors is of the highest standard and provides detail on the expectations of the practice. Go to www.pmetb.org.uk and click on ‘About us' for more information.

Research and audit

If education and training isn't for your practice, maybe research and audit fits your profile. There is an urgent need for both research and researchers in primary care. The level of sophistication required in research methodology means GPs increasingly now work as part of an academic team rather than on lone projects.

The NHS National Institute for Health Research provides information on academic careers – GPs can apply for fully funded fellowships with 25% of their time protected to develop their academic skills. For more information, see www.nihr.ac.uk/ pages/default.aspx.

The RCGP has an Innovation and Research Centre (CIRC), which has been active since October 2007, and integrates the clinical focus of the college with development of primary care research. More information can be found by logging on to www.rcgp.org.uk and clicking on ‘Clinical and research'.

The RCGP also provides a list of research networks throughout the country, including details of fellowships. Go to www.rcgp.org.uk and search for ‘Primary care research networks' for its list of regional networks.

Premises

In September 2006, Pulse reported 1,092 premises out of more than 7,000 across the UK were below minimum standards, and a BMA survey found three-quarters of respondents said their premises were not suitable for their anticipated future needs. But in the past decade there has been a significant investment in primary care estate, the largest contributor being NHS Local Improvement Finance Trusts.

Led by Community Health Partnerships, the LIFT initiative has helped to generate a capital investment of some £2bn across 250 integrated community facilities that are either open or under construction. Your PCT's primary care estates strategy will provide details of its facilities investment programme either through LIFT or by other procurement routes. Most PCTs have carried out an appraisal and identified premises needing investment. For more information, go to www.communityhealth partnerships.co.uk or go to www.dh.gov.uk and search for ‘NHS LIFT FAQ'.

Dr Angela Lennox is senior lecturer in medical education at the University of Leicester and a GP entrepreneur in the city